Tendonitis in the knee

Learn how to get rid of your Patellar Tendonitis in this ultimate guide to curing Jumper’s Knee.

My name is Martin Koban and I suffered from patellar tendonitis (aka “jumper’s knee”) myself. I know how frustrating it can be and since you’re reading this, I don’t have to tell you about it.

To cut a long story short, I almost quit sports altogether before I finally discovered a number of techniques that helped me heal my knees and get back to being active.

I collected this knowledge through years of research and self-experimentation. The techniques you will learn on this page have already worked for thousands of people and professional athletes are using them as well.

If you want to get rid of your patellar tendonitis, this is your holy grail.

Contents

What You’ll Learn on This Page

  • How serious your patellar tendonitis is
  • Why most treatments fail (and maybe yours did too)
  • The 4 Steps to Treat Your Patellar Tendonitis Successfully
  • Which jumper’s knee exercises you should be doing
  • How to recover as quickly as possible

Now let’s get started!

Are Your Symptoms Patellar Tendonitis?

Before we go any further, let’s make sure you’re on the right track by reading this article on jumper’s knee.

Do you feel pain on the side of your kneecap, in front of your kneecap, behind your kneecap, or in the patellar tendon right below the kneecap? If you answered yes, your symptoms indicate patellar tendonitis.

Where you will feel the pain (it can occur in one or both knees)

You use your patellar tendons every time you straighten your knees. All activities that involve this movement can worsen the pain. This includes climbing stairs, squatting, cycling, and walking downhill.

Explosive leg movements, such as jogging, weightlifting, jumping, and sprinting are very likely to worsen the pain, because they store elastic energy inside the tendon (like in a dense rubber band).

Does your pain get worse with any of these activities? If so, it’s another indicator for patellar tendonitis.

Pain & Tendon Rehab: How much is okay?

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It’s not jumper’s knee if …

If your pain is on the side of the knee or behind the knee, you have a different knee injury.

Is your knee swollen? Can you no longer fully bend or straighten the knee? Go see a doctor immediately because you may have a knee injury that requires immediate medical attention.

Regardless of how sure you are about your injury, you always have to visit a doctor to rule out other injuries because if you don’t, you risk permanent damage and lifelong pain.

Is your injury already chronic? (aka “Patellar Tendinosis”)

Patellar tendonitis progresses in stages. Put simply, you can be in the acute stage and in the chronic stage. Resting will only help you get back to 100% if you’re in the acute stage.

You’re in the acute stage if you’re experiencing the pain for the first time and haven’t had it for more than a week or two.

You’re in the chronic stage (patellar tendinosis) if you’ve had the pain several times in the past or have suffered from it for more than a month. Resting alone will not be sufficient to heal your patellar tendon. Instead, you need the right combination of rest and treatment exercises (more on that later).

Chances are you’re in the chronic stage, since most people only start looking for answers once pain becomes more permanent. It’s just human nature. I made that mistake as well. Throughout the rest of this article, I will always talk about the chronic stage when I say tendonitis.

For more details on the injury stages, read 3 Red Flag Symptoms of Patellar Tendonitis.

Why You’re Still In Pain:
The Red Herring of Conventional Treatment

The conventional treatment for patellar tendonitis fails often because it is based on 3 stubborn fallacies that refuse to die. These three red herrings are like an unholy trinity that conspires to damage your patellar tendon even more.

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Fallacy #1: Anti-Inflammatories heal tendonitis

Did you take anti-inflammatories for your patellar tendonitis? Bad news: you may have made things worse!

According to Australian researcher Dr. Jill Cook, using non-steroidal anti-inflammatories such as ibuprofen can be a treatment option in the early stages of tendonitis, but it slows tendon repair once your injury has become chronic (Cook, Purdam 2009, p. 413).

In other words, you MAY use anti-inflammatories to treat ACUTE patellar tendonitis. You have to stop your training during that time and take a few weeks to ease back into it after your treatment has concluded.

BUT, if you’re in the chronic injury stage, academic research says that taking Ibuprofen or other non-steroidal anti-inflammatories (NSAIDs) will slow down your healing (or even prevent healing altogether).

Even worse:

If you’re taking anti-inflammatories while continuing your regular training, you risk causing tendonitis. Here’s why.

Anti-inflammatories slow down soft-tissue adaptation, which means it takes your tendons longer to grow stronger in response to physical training or rehab exercises. Consequently, your risk of soft-tissue injuries such as tendonitis increases when you’re taking anti-inflammatories.

So you may have taken anti-inflammatories for an unrelated health condition and because you continued your regular training, your tendons were too slow to adapt and tendonitis developed.

Damn it Jim! I’m an athlete, not a doctor.

Fallacy #2: Rest is always good

Did you try to heal your chronic patellar tendonitis by resting? More bad news: you wasted precious months doing nothing. But it’s not your fault, since you couldn’t possibly have known. Here’s why resting will not get you back to 100%.

In patellar tendonitis, the small fibers that make up the tendon have become disorganized. A healthy tendon has well-aligned fibers, but if you interrupt the tendon’s adaptation response to training too often (aka overuse), alignment breaks down.

I always liken it to the threads of a steel cable: in tendonitis, the threads have become frayed. The tendon will be weaker and it won’t be able to handle as much force without suffering further damage.

A weakened patellar tendon is like a frayed steel cable.

Normally, the body would repair the damage, but since the body’s attempts for repair have been interrupted so often, it has sort of given up on the repair job. By the way, interrupting this adaptation response is also how anti-inflammatories slow tendon healing.

In chronic tendonitis, the body is no longer actively trying to repair the damaged tendon. If you rest, the fiber alignment inside the tendon will NOT change. Even worse, academic research found that resting too much actually weakens the tendon. (Yamamoto et al. 1999; Cook, Purdam 2009, p. 409)

Resting is like putting the frayed steel cable into a drawer for a week in hopes of it magically repairing itself.

With rest, pain may go down, but the tendon is still weak since its fibers are still messy. If you return to being active, pain will promptly return, as the weakened tendon cannot handle the stress. Maybe you’ve experienced this.

We’ll talk about how you can restart your tendon healing in a moment, but first …

Fallacy #3: Once you’re pain-free, your knee is healthy

After helping people treat patellar tendonitis for years, I’m convinced that this fallacy is the main reason why it keeps coming back. If you can only remember one part of this article, it should be this:

Being pain-free DOES NOT mean your patellar tendon is healthy or strong enough for your sport! You MUST NOT trust your pain (or lack thereof).

In tendonitis, tissue damage occurs before you feel pain (Huisman et al. 2013; Khan et al. 1998, p. 351). Other scientific research discovered that two thirds (66 %!) of tendons so damaged that they’re close to rupture were still pain-free (Kannus, Józsa 1991).

So science says you shouldn’t pop the champagne just because your pain is gone. Even without pain, your tendonitis is lurking in the shadows like Michael Myers, patiently waiting for you to make a mistake (cue Halloween Theme).

Once you found a treatment program that works, follow a slow progression until your pain is completely gone … and then continue the same slow progression for another two or three months minimum, before you even attempt a slow return to sports.

During patellar tendonitis rehab, slow progress is fast progress. To learn more about this, check out Patellar Tendonitis Treatment: Do You Know These Secrets?

Bonus: Have had it for years? Doesn’t matter…

Here’s how you can tell whether you can still get better even if you’ve had patellar tendonitis for years.

Do you want get rid of your tendonitis faster? Join my advanced course today.

Patellar tendon straps can still be beneficial if you need them for pain management during unavoidable daily activities, but beyond that, I’d be careful with them, for the reasons mentioned in the video.

How to Treat Your Patellar Tendonitis Successfully

Everything I know I either learned by reading academic research, through self-experimentation, or by studying the material of movement experts like Dr. Kelly Starrett, Dr. Perry Nickelston, or Dr. Gray Cook (among many others).

I’ve refined the patellar tendonitis treatment I ultimately used to heal my knees down to the following 4 steps. Each step is critical and if you skip one, you’ll be back to where you started.

Again:

Skip any of these steps and you will NOT recover from patellar tendonitis. I’m handing you a detailed map that will guide you through a minefield. There’s no second-guessing involved. It’s not going to be fun all the time either.

Here’s the first step.

Step #1: Stop All Overuse

Here’s an email I get every other day:

“Hey Martin, I was wondering if I could continue while I rehab patellar tendonitis. Is that okay?”

And I get it, I’m an athlete too! I get depressed if I don’t train, so I can definitely relate.

But I’m here to help you get better, not make you worse. I’m not going to prescribe anti-inflammatories or sell you a patellar tendon strap and tell you to keep training. That would be grossly negligent.

Here’s the truth: you cannot rehab patellar tendonitis while you continue your regular training. If you try, you will fail.

Academic research confirms that continuing your regular training stops healing and that athletes should be removed from sports activity during rehab. (Visnes et al. 2005; Visnes, Bahr 2007)

Specifically, you need to avoid all running, jumping, heavy squatting, lunging, and heavy hiking during your rehab, unless it’s part of your rehab protocol. If possible, avoid all activities that cause pain. Focus on training your upper body during the treatment.

This will help you avoid further damage and it’s necessary for step #2 to work. Here’s why.

Step #2: Use Your Pain to Create Your Rehab Program

Before we get to the treatment exercises you will be using, let’s talk about the methodology. The exercises are just minutia compared to how important understanding the methodology is.

To rehab patellar tendonitis, you have to do just the right exercises at just the right time intervals. The goal is for you to achieve a positive adaptation that strengthens your tendon like so:

For your patellar tendon to get stronger you have to do just the right amount of training at the right time.

You will use your pain to discover how often you should train, as well as what type of exercises you should be doing. Once you’ve found the right combination, pain will decrease from week to week.

Pain may stay a bit higher than normal right after your training, but it should drop down to baseline within 24 hours. If pain stays elevated longer than that, you’ve trained too hard.

If pain doesn’t decrease from week to week, you need to experiment by changing one of the following variables during one training month:

  • Removing rest days
  • Adding more rest days
  • Using less intense exercises
  • Using more intense exercises

Again, don’t change all variables at once. You’re like Sherlock Holmes, revealing new evidence to discover how you can crack the case. You need to be systematic and cold-blooded for this to work.

Now you can understand why continuing your regular training will totally screw this process up. Any type of unneeded training will make it harder for you to find the rehab program that works because you won’t be sure if pain is the result of the rehab exercises or your regular training.

Once you found a combination of treatment exercises and rest days that help you reduce your pain, stick with it until it stops decreasing your pain. Then slowly increase the intensity of your exercises by using more resistance without causing a return of pain (hint: go much slower than you think you can).

Step #3: Pass the Secret Test

This is where most people flush all their rehab progress down the toilet: the secret test! It’s like a rite of passage designed by the tendonitis gods and most folks fail this test, unfortunately.

Do you remember treatment fallacy #3? Being pain-free doesn’t mean your patellar tendon is healthy or strong enough for your sport! You MUST NOT trust your pain (or lack thereof). Knowing this is your cheat-code to beat the odds.

During your rehab, you will encounter a point at which your pain is almost completely gone. You’ll feel better than you have in a long time and you will have an itch to return to your favorite activity. If you scratch that itch, you’ll be back to square 1 with your treatment. Here’s why.

Your patellar tendon has gotten stronger as you progressed through your treatment. It’s strong enough for everyday activities and so pain is no longer an issue.

HOWEVER, the tendon is not nearly strong enough for your return to sports yet and if you tried, you’d immediately have a major setback, wasting many weeks of progress.

This is the secret test and to pass it, you need to continue your safe rehab program for at least another 2 months AFTER pain is completely gone before you even attempt a return to your sport. Let’s repeat the important point:

Even after your pain is gone, you need to continue the safe strengthening regimen you discovered in step 2 for at least another 2 months before you attempt any high impact activities.

Step #4: Be Wise Beyond Your Years

Remember back when your parents told you not to do stuff and you did it anyway? Like we tell kids not to touch the hot stove because it’s … well … hot, but they still have to try it, thinking that maybe the laws of the universe didn’t apply to them.

Treating patellar tendonitis is very similar. You’ll be tempted to do things you know you shouldn’t do. For me, this usually was a round of pickup basketball when I knew I wasn’t ready. For you, it’s probably something completely different.

Don’t let your guard down. Increase your activity level gradually, always respecting your patellar tendon’s need for at least 2 or 3 days of rest between intense activities. Remember, the pain is still lurking in the shadows, just waiting for you to make one small mistake.

It’s cold-blooded and calculating, but life is just more fun without pain.

Your Rehab: Use These Patellar Tendonitis Exercises and Stretches

To get rid of your patellar tendonitis, you have to do two types of exercises. Skip them and you’ll eventually have a setback. Here’s the first group.

Exercises to Fix Hidden Causes of Tendon Overload

The patellar tendon is overused through a combination of training too much and hidden biomechanical problems that place excessive stress on the tendon.

As an analogy, think about how wearing tight and wet jeans restrict your movement. You have to exert more energy and moving around is a little tougher on your joints. The same happens to your patellar tendon, as hidden biomechanical problems place more tension on the tendon.

Here’s a list of the most common causes for jumper’s knee:

  • Low ankle mobility
  • Tight calves
  • Tight quadriceps muscles
  • Tight hamstrings
  • Weak gluteal muscles
  • Low hip mobility
  • Soft-tissue problems (muscle knots, trigger points, etc.)

I explain each of these in detail in my book Beating Patellar Tendonitis. We’ll only address the most serious problems in this article.

Again, these issues overload your patellar tendon over time. This happens slowly, over many weeks. To prevent patellar tendonitis from coming back, you need to fix them! Here are exercises you can use to do that.

#1: Self-Massage Exercises for Instant Pain Reduction

The best way to reduce pain from an overused patellar tendon is to release as much tension as possible from your leg muscles. Stretching may be the first thing on your mind in that regard, but for maximum effect, you need to combine stretching with self-massage.

Soft-tissue problems can cause patellar tendon overload.

Self-massage reduces tension in your legs by releasing soft-tissue restrictions in your muscles and it can be very uncomfortable. These restrictions happen when tissues that should glide freely on top of each other are stuck together (after an injury or because of too much sitting and general lack of movement).

Self-massage of the quads led to an immediate pain reduction for many of my readers. It’s like when your stomach hurts after eating too much and the first thing you do is undo your belt buckle. It feels soooooo much better!

To do self-massage, you will need a foam roller or another round object (e.g., a PVC pipe or a tennis ball). Place the roller under your legs and then roll each leg muscle and the muscles on the side of your hip.

I share a video of a great massage technique that you can do at home without a foam-roller in my free advanced course on how to get rid of jumper’s knee. Click here to have me send it to you.

Once you’re done with the self-massage, you can move on to stretching.

#2: Patellar Tendonitis Stretches (for healthy quads, calves, and hamstrings)

People with jumper’s knee tend to have tightness in the calves, the hamstrings, and the quadriceps muscles. They all cross the knee, so any excess tightness places more tension on the patellar tendon.

If you’re running and jumping with tight leg muscles, your legs are working against additional resistance and pain eventually develops. It’s like driving with your handbrake on: instead of breaking records, you’ll break your body.

Before you do any stretches, you must remove all soft-tissue problems in the respective muscle. A muscle with knots and trigger points doesn’t like being stretched and often reacts by becoming even tighter, which we definitely don’t want.

Calf Stretches

Years ago, I discovered that stretching my calves before basketball games helped me reduce pain. Today, I recommend calf stretches to everyone I work with because of how common tight calves are. The most convenient way to stretch your calves is by using a slanted board:

You can achieve a similar effect by placing the balls of your feet on a step and letting your heels drop down like so (You need to wear shoes with a solid but flexible sole for this stretch):

You can also do this stretch by placing the balls of your feet on the curb of the street and letting your heels sink down. That’s what I used to do before basketball games.

Hamstring Stretches

Tight hamstrings are very common today, but you have to be careful with stretching them. Make sure you’ve trained your gluteal muscles because weak gluteal muscles will cause your hamstrings to become overworked, which leads to tightness. We’ll do that with the exercises further down.

For now, here’s how you can stretch your hamstrings:

Lie on your back and use a strap to pull one foot closer to your body. Push against it with your foot for 10 seconds while you pull with your hands. Then release the tension by breathing out with an audible sigh. As you relax, pull your foot a little closer. Repeat for about 2 minutes per side.

Quad Stretches

If these particular patellar tendonitis stretches aggravate your pain, don’t do them. Find an alternative version or stick with the self-massage.

You will need a padded surface for the first quad stretch and I don’t recommend doing without padding, as it’s painful and may injure your knee.

Kneel down in a lunge position and grab the ankle of the rear leg. Next, pull it to your hip. If you notice discomfort in your knee, try moving your knee a bit. I usually lean forward after I grabbed my ankle and then sit up again.

Push your hip forward and sink deeper into the stretch. You can make the stretch more intense by pulling your ankle closer to your hips.

Another variation of this stretch is the couch stretch. Dr. Kelly Starrett of San Francisco Crossfit popularized this variation. Here’s what the couch stretch looks like:

Put your knee into the back corner of the couch and then sit up straight. Don’t round your lower back. Keep your abdominal muscles braced as if you’re bracing for a punch and keep the gluteal muscles of the leg you’re stretching tight.

#3: Hip exercises for better leg alignment

Here’s an analogy to illustrate why good leg alignment is important for a healthy patellar tendon: lifting things off the floor. If you lift with good back alignment, it’s much easier on your spine than if you were to lift with a rounded back, much like running and jumping is easier on your patellar tendon if you move with good leg alignment.

Your feet need to point forward and your knees should track over your toes when you move.

When I go shopping, I usually see many people with knees that cave in towards the midline of their body. Don’t let this happen, it puts excessive strain on the tendon. Also, don’t let your knees come forward when you jump or squat. The shin should stay as close to vertical as possible.

The following hip exercises will help you maintain good leg alignment and thereby help take stress off your patellar tendon. Do 3 sets of 10 to 15 repetitions of each exercise:

Hip Abductions

Lie down on your side with your body in a straight line. Lift the upper leg by leading with the heel. Keep your hip in a right angle to the ground and never move it. You should feel the exertion on the outside of your hip (not your thigh). Here’s what it looks like:

Clamshells

Lie on your side with your legs slightly bent and in front of you. Rotate the upper leg out, just using your hip muscles. Don’t move your hip and don’t push off with your feet.

Glute Bridges

Lie down on your back. Next, slide your heels in so that your middle fingers gently touch your heels. Now, push through your heels to form a straight line from your knees to your shoulders. Poke your buttocks muscles and your hamstrings to make sure your buttocks muscles are tighter.

Finally, here’s how you can stimulate healing in your tendon.

Get Rid of the Pain with This Exercise

All of the previous exercises on this page will help you take tension off the patellar tendon. Reducing tension is crucial to allow healing. Like you have to jack up a car before you can change a flat tire.

This is the BARE MINIMUM of what you need to do to treat your patellar tendonitis. I cover the whole topic in a lot more detail, including a complete training plan, in my book Beating Patellar Tendonitis. Let’s get back to stimulating healing…

In chronic patellar tendonitis (“patellar tendinosis,” as some call it), your body has given up on healing the patellar tendon because you’ve interrupted these healing attempts too frequently.

The fibers in the weakened tendon are a chaotic mess and if all you do is rest, this won’t change. Instead, you need to place controlled tension on the tendon to restart the healing mechanism and then let your body finish its work, before you place higher tension on it again.

Academic research has revealed one exercise to be particularly good at stimulating healing in a damaged patellar tendon: eccentric squats on a slanted board.

How to Do Eccentric Squats for Patellar Tendonitis

This is actually a common physical therapy exercise. Here’s a video demonstrating the technique.

I explain the technique in detail in this article: eccentric slant board squats for patellar tendonitis (or watch the above video). Here are two pictures to give you an idea:

Patellar tendonitis in one knee: place more weight on the injured leg on the way down.

Patellar tendonitis in both knees: support your weight on the way up.

If you don’t have access to a slanted board, you can improvise something similar or build one yourself, if you have tools. Alternatively, do the exercise on flat ground. It’s not as efficient, but it works as well.

We covered a lot of ground in this article. It’s almost 20 pages. My goal is to help you get rid of your patellar tendonitis, so I’ve created a free course that will give you everything you need to get back to enjoying life.

What I will send you:

  • A training plan with all treatment exercises
  • A printable PDF of this article with all exercises
  • My favorite exercise for instant pain relief (video)
  • Whenever I discover a new method to heal even faster, you’ll be the first to know
  • FAQ sessions in which I answer your questions

Have me send you this advanced material and start healing your knees today.

Lastly, please remember what I said earlier:

My goal is to help everyone with patellar tendonitis get back to enjoying their life and I’ve collected the very best techniques to do so on this very page, but I can’t reach everyone myself. I need your help!

Please help me spread the link to this page. Share it with your friends on social media or on your blog.

Show CitationsCook, J. L.; Purdam, C. R. (2009): Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. In British Journal of Sports Medicine 43 (6), pp. 409–416. DOI: 10.1136/bjsm.2008.051193.

Visnes, Håvard; Hoksrud, Aasne; Cook, Jill; Bahr, Roald (2005): No effect of eccentric training on jumper’s knee in volleyball players during the competitive season: a randomized clinical trial. In Clin J Sport Med 15 (4), pp. 227–234.

Show Picture Credit

Whether it’s a painful shoulder, knee or elbow, tendonitis and bursitis are troublesome conditions that can affect just about anyone. The pain can come gradually, building up over time. Or it can feel sudden and severe.

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If you feel concerned or unsure about the cause of pain, see your doctor. But in many cases, it’s sensible to give rest and home remedies time to work.

Tendonitis and bursitis are usually caused by repetitive activities. These include gardening, shoveling, painting, or playing tennis or golf.

What’s happening when these conditions strike is a strain to the tendons that connect bone to muscle (tendonitis) or inflammation to the bursa, fluid-filled sacs that reduce friction in the joints (bursitis). Since every joint has a bursa, these two conditions often go hand-in-hand.

They are especially common in the rotator cuff of the shoulder and in the patellar tendon that connects the knee cap to the shin bone.

Start treatment at home

In most cases, you can treat tendonitis and bursitis at home with rest, ice and over-the-counter anti-inflammatories, such as ibuprofen or naproxen. It may seem simple, but also try to avoid the motion that originally caused the pain.

Give about four to six weeks for these home remedies to help. But if the pain persists, call your doctor.

Latest treatment options

If tendonitis and bursitis are still causing pain after treating them at home, your doctor will often start your treatment with physical therapy. It can help to alleviate symptoms as well as strengthen the area of injury.

There are other options that are sometimes used to treat tendonitis and bursitis:

  • Phonophoresis: This technique uses ultrasound to help anti-inflammatory creams absorb through the skin.
  • Iontophoresis: Similar to phonophoresis, this technique uses electrical stimulation to help anti-inflammatories penetrate the skin.
  • Cortisone injections: Injections of this steroid medication can help significantly reduce the inflammation that comes with persistent tendonitis and bursitis.

Listening to your pain

Some people think that pain is a sign that something damaging is going on in their bodies. But that’s not always the case. Tendonitis and bursitis may cause temporary pain and discomfort, but they usually don’t cause long-term damage and rarely require surgery.

Take tendonitis and bursitis for what they are — overuse injuries that are common and easy to begin treating at home. Often, this is all they need to resolve. If they don’t within a month or so, call your doctor.

Patellar Tendonitis (Jumper’s Knee)

What is jumper’s knee?

Jumper’s knee, also known as patellar tendonitis, is a condition characterized by inflammation of your patellar tendon. This connects your kneecap (patella) to your shin bone (tibia). Jumper’s knee weakens your tendon, and, if untreated, can lead to tears in your tendon.

What causes jumper’s knee?

Jumper’s knee is caused by overuse of your knee joint, such as frequent jumping on hard surfaces.

It’s usually a sports-related injury, linked to leg muscle contraction and the force of hitting the ground. This strains your tendon. With repeated stress, your tendon may become inflamed.

What are the symptoms of jumper’s knee?

Following are the most common symptoms of jumper’s knee. However, you may experience symptoms differently. Symptoms may include:

  • Pain and tenderness around your patellar tendon
  • Swelling
  • Pain with jumping, running, or walking
  • Pain when bending or straightening your leg
  • Tenderness behind the lower part of your kneecap

The symptoms of jumper’s knee may resemble other conditions or medical problems. Always see your healthcare provider for a diagnosis.

How is jumper’s knee diagnosed?

In addition to a complete medical history and physical exam, your healthcare provider may use an X-ray to help diagnose jumper’s knee.

How is jumper’s knee treated?

The best treatment for jumper’s knee is to stop any activity that’s causing the problem until the injury is healed. Other treatment may include:

  • Nonsteroidal anti-inflammatory medicines (NSAIDs, like ibuprofen or naproxen)
  • Rest
  • Elevating your knee
  • Ice packs to your knee (to help reduce swelling)
  • Stretching and strengthening exercises

Key points

  • Jumper’s knee is inflammation of your patellar tendon, the tendon that connects your kneecap (patella) to your shin bone (tibia).
  • Jumper’s knee is a sports-related injury caused by overuse of your knee joint.
  • Common signs of jumper’s knee include:
    • Pain and tenderness around your patellar tendon
    • Swelling
    • Pain with jumping, running, or walking
    • Pain when bending or straightening the leg
    • Tenderness behind the lower part of the kneecap
  • Jumper’s knee is diagnosed by taking a medical history and doing a physical exam. Sometimes an X-ray may be needed.
  • The best treatment for jumper’s knee is to stop any activity that’s causing the problem until the injury is healed. Other treatment may include:
    • Nonsteroidal anti-inflammatory medicines
    • Rest
    • Elevating the knee
    • Ice packs to the knee (to help reduce swelling)
    • Stretching and strengthening exercises

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

What Is Patellar Tendonitis (Jumper’s Knee)?

Treatment depends on the severity of your injury.

Conservative measures to reduce pain, rest your leg, and stretch and strengthen your leg muscles are generally the first line of treatment. Your doctor will usually advise a period of controlled rest, where you avoid activity that puts force on the knee.

Medication

Your doctor may prescribe over-the-counter (OTC) drugs for short-term pain and inflammation reduction.

These can include:

  • ibuprofen (Advil)
  • naproxen sodium (Aleve)
  • acetaminophen (Tylenol)

If your pain is severe, your doctor may give you a corticosteroid injection in the area around your patellar tendon. This is more effective in reducing severe pain. However, the Mayo Clinic reports that it also may weaken the tendon and possibly make it more likely to rupture. So, it’s important to put considerable thought into this treatment and its associated risks.

Another way of delivering corticosteroid is by spreading the drug over your knee and using a low electrical charge to push it through your skin. This is called iontophoresis.

Therapy

The goal of physical therapy is to reduce your pain and inflammation and to stretch and strengthen your leg and thigh muscles.

If your pain is severe even while you are resting your legs, your doctor may advise that you wear a brace and use crutches for a while to avoid further damage to the tendon. When you’re relatively pain free, you can begin physical therapy activities.

A therapy session generally includes:

  • a warm-up period
  • ice or massage for your knee
  • stretching exercises
  • strengthening exercises

Your therapist may also use ultrasound and electrical stimulation to ease your knee pain. A knee brace or taping of your knee may help reduce pain when you are exercising by keeping the kneecap in place.

Your physical therapist will develop an exercise program for you that may include the following:

  • Stretches.
  • Isometric exercises, where your joint angle and muscle length remain fixed during contractions. This reported to relieve pain.
  • Eccentric exercises, which are squats performed on a decline board that is at a 25-degree angle. A 2005 study found that this method of strengthening led to better improvement in athletes with patellar tendonitis who continued to play while being treated.
  • Flexibility exercises for the thigh and calf.

Alternative treatments

A relatively new treatment is a platelet-rich plasma injection. This uses a concentration of platelets from your own blood to promote healing of the tendon. A 2015 study found that two consecutive injections were more effective than a single injection.

Other alternative treatments under study include:

  • Ultrasound-guided dry needling: This process makes small holes in the tendon. This is called dry needle fenestration and has been found to relieve pain and help healing.
  • Injections with polidocanol: This aims at breaking up new blood vessels on the tendon, which are associated with pain.
  • High volume ultrasound-guided injections: This also aims at breaking up new blood vessels on the tendon.
  • Hyperthermia thermotherapy: This uses deep-tissue heating along with a cooling device on the skin surface to relieve pain.
  • Extracorporeal shockwave therapy: This has shown to reduce pain for up to two years.

Surgery

When other treatments aren’t successful in relieving pain, your doctor may advise surgery to repair the patellar tendon.

Traditional surgery involves opening the knee to scrape the knee cap and tendon. More recently, arthroscopic surgery is used for this procedure. This involves making only four small incisions in the knee, and it has a shorter recovery time.

Recovery time from surgery varies. Some surgical protocols advise immobility in a cast after your operation. Another strategy for healing suggests that an aggressive and immediate rehabilitation exercise program works best. In this protocol, people were able to return to high-level activity in three months to a year.

Taming tendinitis in the knee

Tendons are the bands of fibrous tissue that attach muscle to bone. Tendinitis — tendon inflammation — is often a repetitive strain injury. You get it by repeating the same motion over and over, which irritates the tendon. Joints commonly affected by tendinitis include the elbow, heel, and wrist.

Weekend warriors (folks who engage in high-intensity activities such as running or basketball on the weekend but do little to maintain conditioning during the week) often develop tendinitis in the knees. Simply being overweight can also contribute to knee tendinitis. Age is another risk factor. Over time, tendons become less flexible and the involved muscles lose strength, both of which further stress the tendons. Inflexible hamstring and quadricep muscles make you more susceptible as well.

Symptoms of tendinitis of the knee include:

  • pain above or below the kneecap
  • swelling
  • pain that recurs with particular activities and eases with rest
  • in severe cases, pain becomes constant (in spite of resting the joint) and can even disrupt sleep

Here are some simple steps you can take to quell tendinitis pain. At the first sign of trouble:

  • limit activities that put stress on your knees
  • apply ice
  • use over-the-counter pain relievers, ideally aspirin or another nonsteroidal anti-inflammatory like ibuprofen or naproxen
  • use a knee support.

Once the pain and any swelling are gone, try easing back into your normal activities and hold off on more demanding athletic activities for a few weeks. Typically, tendinitis goes away in a few weeks or months. Your doctor may recommend extra treatments for particularly stubborn cases.

To keep tendinitis from coming back, ask your doctor about exercises to improve flexibility and address and muscle imbalances that may be placing stress on your knees.

For more information on recognizing and treating knee tendinitis as well as ligament issues, tissue tears, osteoarthritis and other knee conditions, buy Knees and Hips, a Special Health Report from Harvard Medical School.

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

What Is Tendinitis?

Got knee pain? If you’re an athlete or fitness enthusiast, you may have tendinitis. “Many people who participate in sports or fitness activities will get tendinitis at one time or another,” says Steven Stuchin, MD, director of orthopaedic surgery at NYU Hospital for Joint Diseases in New York City. The result can be severe knee pain.

What Is Tendinitis?

Tendinitis is an inflammation of the tendon, a flexible band of tissue that connects the muscles to the bones. The pull of the muscles is transmitted to the bone by the tendons, which allows movement. When the tendons are inflamed, the pulling action of the muscle is impaired and movement becomes painful. There are several large tendons around the knee area. When one or more of them becomes inflamed, this is called knee tendinitis.

Tendinitis Symptoms and Risk Factors

“Pain with movement is the most common symptom of knee tendinitis,” says Dr. Stuchin. Moving even slightly can cause severe knee pain. The pain will be worse when running, walking fast, or going up and down stairs. There may also be swelling from the inflammation.

Overuse is a common risk factor for tendinitis. When the tendon is stretched repeatedly by doing the same kind of exercise over a long period of time, the tendon can become strained and inflamed. Runners often get tendinitis for this reason. Tendinitis can also be caused by intense exercise over a short period of time. “Someone who tries to get in all their exercise over the weekend is a prime candidate for tendinitis,” says Stuchin. Being middle age or older is another risk factor. Tendons become more brittle with age, making them vulnerable to stress and strain.

Another type of knee pain caused by tendinitis is called jumper’s knee. In this type of tendinitis, injury to the knee occurs with jumping activities when too much strain is placed on the patellar tendon, which connects the kneecap (patella) to the shinbone. Pain is felt directly over the patellar tendon. “You’ll feel pain just below the kneecap,” says Stuchin. There may be inflammation too. Jumper’s knee is common among basketball and volleyball players.

Treating Tendinitis

Tendinitis doesn’t normally require a doctor’s care. Follow these recommendations to relieve the knee pain.

  • Rest. Refrain from the activity that caused the tendinitis. “The more you work the tendon by running or jumping, the worse the injury will become and the longer recovery will take,” says Stuchin.
  • Ice. Apply ice wrapped in a towel for 15 minutes once or twice a day. Ice helps reduce swelling, which will lessen knee pain and speed healing of the tendon.
  • Elevate. Lie down and place your knee on a pillow so that it’s higher than your heart. This will aid blood flow and help reduce swelling.
  • Take OTC medicine. “I recommend taking over-the-counter non-steroidal anti-inflammatory medications, such as ibuprofen and naproxen,” says Stuchin. “They not only relieve pain, but they also reduce swelling.” Advil, Motrin, and Aleve are examples of these medications.
  • Compress. Wrapping the knee in an elastic knee bandage can help reduce swelling and ease knee pain.
  • Ease back into activity. After your tendinitis disappears, don’t immediately go back to the same level of activity that caused your knee pain. Overdoing it can cause a recurrence of tendinitis. Warm up and stretch before beginning exercise. Then go slowly for a few weeks.

Recovering from tendinitis requires patience. With proper care, the knee pain will become less noticeable in about three weeks, but complete healing from tendinitis may require six weeks, says Stuchin. By taking it easy for a month or so, your tendinitis should disappear and you’ll be on the go again.

How Long Does Patellar Tendonitis Take To Heal?

I first began suffering the pain and symptons of patellar tendonitis near the start of this year. It has taken a long time to recover from this painful condition and every now and then I still feel a ‘tweak’ of pain in my knee.

Naturally, I find myself wondering how long it could take before my patellar tendonitis eventually heals completely.

Image: “Blausen gallery 2014”. Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762.

I have written two prevous articles about this condition and my experience of it. If you are investigating patellar tendonitis for the first time as a result of developing recent knee pain then you may wish to read my earlier articles:

What is patellar tendonitis?
In this article I share researched information about who is at risk of developing patellar tendonitis as well as likely contributing risk factors. The main cause is simply overuse, a common risk factor for any sports enthusiast.

How to treat patellar tendonitis
As I stated in this particular article I am not unfamiliar with injuries and feel confident to self-manage most niggles I pick up from time to time. However, patellar tendonitis has been a different scenario for me. What I thought I could self-manage turned out to be a foolish idea – eventually leading to a more serious condition and one that has taken much of this entire year to heal – and I’m not yet 100%.

This is the 3rd article in this series and I will share a little insight into the healing stage referred to as ‘Progression’.

Following stage 1 – controlled rest, I moved into stage 2 – progression roughly 4 months after first recognising I had patellar tendonitis.

Progression

Building on the need to strengthen the patellar tendon, which requires direct ‘stress’ to it in the form of specific squatting technique, I progressed to full body weight bearing squat exercises.

I knew I was ready to progress to this stage when the pain, after performing the strengthening exercises in stage 1, no longer appeared. After some amount of time, weeks, of performing body weight squats without pain I gradually added weight/resistence to the exercise.

I have a 5kg medicine ball which is comfortable to hold close to my chest when performing the squat. I have been cautious about how far I extend into the squat – meaning I do not allow my thighs to travel beyond the horizontal line with my knees. As I have progressed I have also increased the speed and number of reps of my squat exercises.

Return to sports

I have returned to most sporting activites but not all.

In the gym I am doing barbell and quad bar squats with approx. half the weight load I was previously capable of lifting prior to the injury. I am now more focused on conditioning and maintaining strength rather than growing/building muscle or greater strength.

I cannot run like I did prevously. The recurring impact forces on the knee cause pain to return, not as severe but it is there. I have experimented with forefoot strike running techniques as well as others but none seem to improve the condition. I am not optimally built as a runner so this is one activity I am happy to leave out of my routine for now.

I can kite surf for 2-3 hours in one session which involves a lot of pressure on the knees, especially landing jumps and stuff like that. Just yesterday I was out on the water and by the end of a 3 hour surf my ‘bad’ knee was feeling it – more an ache than pain, but no loss in performance.

Conclusion

The knee, like most joints, are so very critical to our everyday function, especially if we are active people. Losing performance in my knee had a significant impact on my life. So much so that it has left me far more cautious about how I train. This is surely a good thing.

Patellar tendonitis is one of those conditions that doesn’t simply heal with rest and ice compression. This condition requires active rehabilitation and the longer it is left untreated the longer it will take to heal, with the potential for 6-12 months required before full recovery is achieved.

If you suspect patellar tendonitis is the cause of your knee pain, even if you are unsure, my recommendation is to get it professionally assessed as soon as possible. A Chartered Physiotherapist is optimally qualified to assess and advise treatment and care for patellar tendonitis.

If you are already suffering with this condition – hang in there and don’t lose focus or motiavtion to do your rehab exercises. They are crucial for the recovery process.

Robin

Orthopedics:Conditions & Treatments

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Patellar Tendonitis

Patellar tendinitis is characterized by inflammation and pain at the patellar tendon (the tendon below the kneecap). This structure is the tendon attachment of the quadriceps (thigh) muscles to the leg, which is important in straightening the knee or slowing the knee during bending or squatting. Patellar Tendonitis is typically a grade 1 or 2 strain of the tendon. A grade 1 strain is a mild strain. There is a slight pull without obvious tearing (referred to as microscopic tendon tearing). There is no loss of strength, and the tendon is the correct length. A grade 2 strain is a moderate strain, which involves tearing of tendon fibers within the substance of the tendon or at the bone-tendon junction. The length of the tendon is usually increased, and there is decreased strength. A grade 3 strain is a complete rupture of the tendon.

Common Signs & Symptoms of Patellar Tendonitis

  • Pain, tenderness, swelling, warmth, or redness over the patellar tendon, most often at the lower pole of the patella (kneecap) or at the tibial tubercle (bump on the upper part of the lower leg)
  • Pain and loss of strength (occasionally) with forcefully straightening the knee (especially when jumping or when rising from a seated or squatting position) or bending the knee completely (squatting or kneeling)
  • Crepitation (a crackling sound) when the tendon is moved or touched

Patellar Tendonitis Causes

  • Strain from a sudden increase in amount or intensity of activity or overuse of the quadriceps muscles and patellar tendon
  • Direct blow or injury to the knee or patellar tendon

Patellar Tendonitis Risk Increases With:

  • Sports that require sudden, explosive quadriceps contraction (jumping, quick starts, or kicking)
  • Running sports, especially running down hills
  • Poor physical conditioning (strength and flexibility, such as with weak quadriceps or tight hamstrings)
  • Flat feet

Patellar Tendonitis Preventive Measures

  • Appropriately warm up and stretch before practice or competition
  • Allow time for adequate rest and recovery between practices and competition
  • Maintain appropriate conditioning:
    • Cardiovascular fitness
    • Thigh and knee strength
    • Flexibility and endurance
  • To help prevent recurrence, taping, protective strapping or bracing, or an adhesive bandage may be needed for several weeks after healing is complete
  • Wear arch supports (orthotics)

Expected Outcome

  • Patellar Tendonitis is usually curable within 6 weeks if treated appropriately with conservative treatment and resting of the affected area.

Possible Complications

  • Prolonged healing time if not appropriately treated or if not given adequate time to heal
  • Recurrence of symptoms if activity is resumed too soon, with overuse, with a direct blow, or when using poor technique
  • Untreated, tendon rupture requiring surgery

Physio Works – Physiotherapy Brisbane

Article by J. Miller, Z. Russell

What is a Knee Ligament?

A ligament is a short band of tough fibrous connective tissue composed mainly of long, stringy collagen molecules. Ligaments connect bones to other bones in and around joints. They do not connect muscles to bones; that is the function of tendons. Ligaments limit the amount of mobility of a joint, or prevent certain movements altogether.

What Causes Knee Ligament Injuries?

You can injure a ligament through a sharp change in direction, landing wrong from a jump, or the most common a blunt force hit to the knee, such as in football tackle. The incident usually needs to happen at speed. Muscle weakness or incoordination predispose you to a ligament sprain or tear.

Major Knee Ligaments

  • ACL: Anterior Cruciate Ligament
  • PCL: Posterior Cruciate Ligament
  • MCL: Medial Collateral Ligament
  • LCL: Lateral Collateral Ligament
  • Coronary Ligament

How Do You Know If Your Knee Injury Is Serious?

While it is always best to seek the professional advice of a highly skilled practitioner who is trained in knee injuries such as your doctor or physiotherapist, here are seven signs that could indicate a severe knee injury.

  1. Obvious deformity. You may have a fracture or dislocation.
  2. You heard a “pop” or “snap”
  3. You’ve experienced swelling
  4. Greater than normal movement
  5. Less than normal movement eg can’t straighten
  6. You are unable to weight-bear on your leg
  7. Your knee “gives way” or “buckles”.

If you experience any of these symptoms please seek prompt medical assessment.

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Symptoms & Severity of Knee Ligament Injuries?

The severity and symptoms of a ligament sprain depend on the degree of stretching or tearing of the ligament.

In a mild grade I sprain, the ligaments may stretch, but they don’t actually tear. Although the joint may not hurt or swell very much, a mild sprain can increase the risk of a repeat injury.

With a moderate grade II sprain, the knee ligament tears partially. Swelling and bruising are common, and the use of the joint is usually painful and difficult.

With a severe grade III sprain, your ligament tears completely, causing swelling and sometimes bleeding under the skin. As a result, the joint is unstable and unable to bear weight. Often there will be no pain following a grade III tear as all of the pain fibres are torn at the time of injury.

What’s the Healing Time of a Knee Ligament Injury?

Treatment of a ligament injury varies depending on its location and severity.

Grade I sprains usually heal within a few weeks. Maximal ligament strength will occur after six weeks when the collagen fibres have matured. Resting from painful activity, icing the injury, and some anti-inflammatory medications are useful. Physiotherapy will help to hasten the healing process via electrical modalities, massage, strengthening and joint exercises to guide the direction that the ligament fibres heal. This helps to prevent a future tear.

When a grade II sprain occurs, use of a weight-bearing brace or some supportive taping is common in early treatment. This helps to ease the pain and avoid stretching of the healing ligament. After a grade II injury, you can usually return to activity once the joint is stable and you are no longer having pain. This may take up to six weeks. Physiotherapy helps to hasten the healing process via electrical modalities, massage, strengthening and joint exercises to guide the direction that the ligament fibres heal. This helps to prevent a future tear and quickly return you to your pre-injury status.

When a grade III injury occurs, you usually wear a hinged knee brace to protect the injury from weight-bearing stresses. The aim is to allow for ligament healing and gradually return to normal activities. These injuries are most successfully treated via physiotherapy and may not return to their full level of activity for 3 to 4 months. We strongly recommend that you seek professional advice in these cases.

Knee Pain

Common Causes

Knee Ligament Injuries

  • Knee Ligament Injuries
  • ACL Injury
  • PCL Injury
  • MCL Sprain
  • LCL Sprain
  • Posterolateral Corner Injury
  • Superior Tibiofibular Joint Sprain

Knee Meniscus

  • Meniscus Tear
  • Discoid Meniscus

Knee Tendonitis

  • Patella Tendonitis (Tendinopathy)
  • Pes Anserinus Tendinitis
  • Popliteus Tendinitis

Muscle Injuries

  • Corked Thigh
  • Thigh Strain
  • Hamstring Strain
  • ITB Syndrome
  • Popliteus Syndrome
  • Muscle Strain (Muscle Pain)
  • Cramps
  • DOMS – Delayed Onset Muscle Soreness

Knee Bursitis

  • Bursitis Knee
  • Pes Anserinus Bursitis

Children’s Knee Conditions

  • Osgood Schlatter’s
  • Sinding Larsen Johansson Syndrome

Other Knee-Related Conditions

  • Runner’s Knee
  • Plica Syndrome
  • Fibromyalgia
  • Stress Fracture
  • Overuse Injuries
  • Restless Legs Syndrome
  • Sciatica

Knee Surgery

  • Knee Arthroscopy
  • Knee Replacement

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Common Treatments for a Knee Ligament Injuries

  • Early Injury Treatment
  • Avoid the HARM Factors
  • Soft Tissue Injury? What are the Healing Phases?
  • What to do after a Muscle Strain or Ligament Sprain?
  • Acupuncture and Dry Needling
  • Sub-Acute Soft Tissue Injury Treatment
  • Closed Kinetic Chain Exercises
  • Gait Analysis
  • Biomechanical Analysis
  • Balance Enhancement Exercises
  • Proprioception & Balance Exercises
  • Agility & Sport-Specific Exercises
  • Medications?
  • Soft Tissue Massage
  • Brace or Support
  • Dry Needling
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Joint Mobilisation Techniques
  • Kinesiology Tape
  • Neurodynamics
  • Prehabilitation
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • Yoga
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    Helpful Products for Knee Ligament Injuries

    FAQs for Knee Ligament Injuries

  • Common Physiotherapy Treatment Techniques
  • What is Pain?
  • Physiotherapy & Exercise
  • When Should Diagnostic Tests Be Performed?
  • What are the Symptoms of an ACL Tear?
  • What Causes Post-Exercise Muscular Pain?
  • Can Kinesiology Taping Reduce Your Swelling and Bruising?
  • Heat Packs. Why Does Heat Feel So Good?
  • How Can You Prevent a Future Leg Injury?
  • How Do You Improve Your Balance?
  • How Much Treatment Will You Need?
  • Post-Run Soreness: Should You Be Concerned?
  • Runners: How to Reduce Your Knee Stress
  • Sports Injury? What to do? When?
  • What are the Common Massage Therapy Techniques?
  • What are the Early Warning Signs of an Injury?
  • What is a TENS Machine?
  • What is Chronic Pain?
  • What is Nerve Pain?
  • What is Sports Physiotherapy?
  • What’s the Benefit of Stretching Exercises?
  • When Can You Return to Sport?
  • Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker
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